Community treatments are failing to relieve pressure on in-patient wards

Psychiatric in-patient services are being neglected in favour of community treatments, with some in a state of permanent crisis, according to a report by a mental health watchdog.

The biennial report by the Mental Health Act Commission found in-patient services were running at maximum capacity, with little evidence that community services were relieving the pressure.

Half of all wards were full or had more patients than beds, it revealed.

In-patient services were particularly vulnerable to spending cuts being imposed by many NHS trusts to meet their deficits, with the commission saying it was “increasingly seeing mental health services at crisis level”.

And the report warned that patients subject to compulsion could end up on failing wards because they would not be able to choose their treatment under new market-based systems of funding.

Andrew McCulloch, chief executive of the Mental Health Foundation, said that mental health services were still the poor relation in the NHS and psychiatric in-patient services were bearing the brunt of pressure. “However, it is not about calling for more resources for outmoded in-patient services and we need to question whether many in-patient services can ever be therapeutic environments for people with mental health problems,” he added.

The study, based on visits to detained patients in England and Wales from 2003-5, restated the commission’s opposition to the draft Mental Health Bill.

It argued that the government should tackle the poor standard of many in-patient wards, which created fear of services among patients and “potential problems with compliance”, rather than extend statutory powers of coercion.

The commission said there were already various powers to coerce community-based patients.

The report found declining rates of diversion from prison to hospital and suggested there were now more people in prison with a serious mental disorder than at any time since the implementation of the Mental Health Act 1983. It argued that mandatory sentencing had prevented the diversion of offenders with mental health problems from the criminal justice system.